The quality-adjusted life-year (QALY) and the disability-adjusted life-year (DALY) are widely used to evaluate healthcare interventions and quantify the burden of disease. Some people also use these metrics informally as a general indicator of value. However, they have a number of major shortcomings in their current form. For example:
The main alternative, often used within central government, is cost-benefit analysis. CBA allows direct comparisons both within and across domains by expressing all outcomes in monetary terms. (See the UK Treasury’s Green Book for an example of this approach.) However, it generally relies on stated or revealed preferences, which are often a poor measure of welfare for a variety of reasons.
These problems lead to serious misallocation of resources in public institutions, such as national governments, and in some non-profit entities as well.
An alternative metric is the wellbeing-adjusted life-year (WELLBY). This is structurally identical to the QALY but quantifies value in terms of subjective wellbeing (SWB), typically measured using self-reported happiness or life satisfaction.
In the conference talk below, Michael Plant and Clare Donaldson of the Happier Lives Institute cover some of the issues with currently widely used measures of impact and explain the benefits of the WELLBY as an alternative.
A handful of economists have worked specifically on a WELLBY for general use, including Paul Frijters, Christian Krekel and Richard Layard. Dozens of others economists have worked on closely related issues, including Andrew Clark, John Helliwell, Jan De Neve, Nick Powdthavee, Redzo Mujcic, Alois Stutzer and Martijn Burgers. Health economists such as Tessa Peasgood, John Brazier and Paul Dolan have promoted the use of wellbeing in healthcare prioritisation.
In psychology and behavioural science, some key figures include Daniel Kahneman, Paul Dolan, Ed Diener, Martin Seligman and Sonja Lyubomirsky.
Specific research includes:
The Happier Lives Institute and the Happiness Research Institute are organisations using wellbeing adjusted life years to inform decision-making.
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